Provider Demographics
NPI:1588758486
Name:KILKENNY, JILL (PT)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:KILKENNY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 NORTHLAND CT NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-6226
Mailing Address - Country:US
Mailing Address - Phone:319-377-0937
Mailing Address - Fax:319-377-0948
Practice Address - Street 1:227 NORTHLAND CT NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-6226
Practice Address - Country:US
Practice Address - Phone:319-377-0937
Practice Address - Fax:319-377-0948
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03148225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0665430Medicaid
IA2204667Medicaid
IAIB1213Medicare PIN
IAIB1212011Medicare PIN
IAIB1212Medicare PIN
IA0665430Medicaid
IAI19172Medicare PIN